Healthcare Provider Details

I. General information

NPI: 1538119540
Provider Name (Legal Business Name): MEHRAN TIRANDAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 EUCLID STREET RADIOLOGY DEPARTMENT
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

PO BOX 3148
MISSION VIEJO CA
92690-1148
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-7200
  • Fax: 714-966-8039
Mailing address:
  • Phone: 949-348-1105
  • Fax: 949-348-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG85399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: